TCT-145 Relationship Between Preprocedural Blood Pressure and Outcomes in Patients Undergoing Impella-Supported High-Risk PCI: Insights From the cVAD PROTECT III Study

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Background: Temporary left ventricular assist devices (LVADs) are often used to prevent hypotension during high-risk percutaneous coronary intervention (HRPCI). The impact of preprocedural blood pressure (BP) on outcomes during HRPCI is unknown. Methods: Patients from the cVAD PROTECT III study undergoing Impella-supported HRPCI were divided based on preprocedural BP. Procedural outcomes included hypotensive episodes and in-hospital death. Clinical endpoints were 90-day major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeated revascularization) and 1 year mortality. Results: Patients (n = 1,159) who underwent Impella-supported HRPCI with baseline BP were evaluated: mean arterial pressure (MAP) >100 mm Hg (n = 242), >90-100 mm Hg (n = 264), >80-90 mm Hg (n = 306), and ≤80 mm Hg (n = 347). Lower preprocedural MAP was associated with baseline anemia, history of heart failure, left main disease, and transfer from another hospital. In-hospital and procedural outcomes did not differ between groups. However, 90-day MACCE rates and 1-year mortality increased with decreasing baseline BP levels (Figure 1). The association between BP category and 1-year mortality remained significant after adjustment (P < 0.001). [Formula presented] Conclusion: In a cohort of protected HRPCI with Impella, procedural hemodynamic stability was high. Although there was no association between baseline BP levels and in-hospital outcomes, lower preprocedural BP was associated with higher rates of 1-year mortality, which was related to differences in baseline clinical characteristics. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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